Foot Disorders

Overview A hammertoe is a deformity in the foot, causing the second, third, or fourth toe to be permanently bent in the middle joint, causing the toe to resemble a hammer (hence, its name!) or a claw. They are most commonly found in women who wear narrow shoes, such as high heels, that cause the toes to bend unnaturally for extended periods of time. A Hammertoe may be difficult or painful to move, and the skin may become callused from rubbing against the inside of the shoe. In fact, there are two types of hammertoe: flexible and rigid. Flexible hammertoes can still move at the joint and are indicative of an earlier, milder form of the problem. Rigid hammertoes occur when the tendon no longer moves, and at this stage, surgery is usually necessary to fix the problem.

Causes People who are born with long bones in their toes are more likely to develop hammer toe. Children who wear shoes they have outgrown may develop this condition. People who wear very narrow shoes or high-heeled shoes are also more likely to develop a hammer toe. Sometimes, pressure from a bunion can cause hammer toe. Rheumatoid arthritis is another a risk factor.

Symptoms If you have any of these symptoms, do not assume it is due to hammer toe. Talk to your doctor about symptoms such as a toe that curls down, corns on the top of a toe, calluses on the sole of the foot or bottom of the toe, pain in the middle joint of a toe, discomfort on the top of a toe, difficulty finding any shoes that fit comfortably, cramping in a toe, and sometimes also the foot and leg, difficult or painful motion of a toe joint, pain in the ball of the foot or at the base of a toe.

Diagnosis Your doctor is very likely to be able to diagnose your hammertoe simply by examining your foot. Even before that, he or she will probably ask about your family and personal medical history and evaluate your gait as you walk and the types of shoes you wear. You'll be asked about your symptoms, when they started and when they occur. You may also be asked to flex your toe so that your doctor can get an idea of your range of motion. He or she may order x-rays in order to better define your deformity.

Non Surgical Treatment Apply a commercial, non-medicated hammer toe pad around the bony prominence of the hammer toe to decrease pressure on the area. Wear a shoe with a deep toe box. If the hammer toe becomes inflamed and painful, apply ice packs several times a day to reduce swelling. Avoid heels more than two inches tall. A loose-fitting pair of shoes can also help protect the foot while reducing pressure on the affected toe, making walking a little easier until a visit to your podiatrist can be arranged. While this treatment will make the hammer toe feel better, it is important to remember that it does not cure the condition. A trip to the podiatrist's office will be necessary to repair the toe to allow for normal foot function. Avoid wearing shoes that are too tight or narrow. Children should have their shoes properly fitted on a regular basis, as their feet can often outgrow their shoes rapidly.

Surgical Treatment Surgery is the approach that is often necessary to correct hammertoe that fails to respond to nonsurgical management. Surgery is appropriate when the muscles and tendons involved in a hammertoe problem have become so tight that the joints are rigid, misaligned and unmovable. There are a number of surgical techniques for dealing with the complex range of joint, bone, muscle, tendon and ligament abnormalities that define each hammertoe's make-up. To correct a hammertoe deformity, the surgeon's goal is to restore the normal alignment of the toe joint, relieving the pressure that led to the hammertoe's development (this should also relieve the pain, as well). To do this, he or she may remove part of the boney structure that creates a prominence at the top of the joint. Tighten or loosen the muscles, tendons and ligaments around the toe joints. Realign the toebones by cutting one or more and shifting their position, realigning muscles, tendons and ligaments accordingly. Use screws, wires or plates to hold the joint surfaces together until they heal. Reconstruct a badly damaged joint or replace it with an artificial implant.